12040096CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20488 STEVENS CREEK BLVD
CONTRACTOI
�� �E�
PERMIT NO: 12040096
OWNER'S NAME: STEVENS CREEK COMMERCIAL, LLC
DATE ISSUED: 04/20/2012
OWNER'S PHONE: 404730121
, I J Al
PHONE NO:
❑ ^ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT � r—
PLUMB
��
License Class
r RESIDENTIAL F COMMERCIAL r—
Contracto n\A4-M Date 4—n't-L
MECH
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: DEMO EXISTING CONCRETE RAMP & REPLACE WITH
(commencing with Section 7000.) of Division 3 of the Business & Professions
NEW
RAMP & STRIPPING
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $5200
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36953207.00
Occupancy Type:
I certi d this application and state that the above information is
co ct. I agree to comp and county ordinances and state laws relating
to uilding constructio ,y authorize representatives of this city to enter
up the above conefor inspection purposes. (We) agree to save
rode ify cep harmity of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, d penses whicrue against said City in consequence of the
Lthnity
grantin this permit. Aly, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with oint source ns per the Cupertino Municipal Code, section180
DAYS FROM LAST CALLED INSPECTION.
9.18.Signature
aDate7�1
Issued by: i �fy%1� �i�TGt�L Date: V.774.%,�L
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
constrict the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
l have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
co ce with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, ection 25532(a) should I store or handle hazardous material.
permit is issued.
Additional) should I use equipment or devices which emit hazardous air
f certify that in the performance of the work for which this permit is issued, I sh I
con'ami is as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maim ' co Hance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Heal & Safe ode, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
O or �t �1 h
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
I hereby affirm that there is a construction lending agency for the performance of work's
to building constriction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM-1 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20488 Stevens Creek Blvd
DATE: 04/17/2012
REVIEWED BY: Sean
APN:3
BP#:
Q
'VALUATION: 1$5,200
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
DEMO EXISTING CONCRETE RAMP & REPLACE W/ NEW RAMP & STRIPPING
SCOPE
ri, Plan c'ir<•r6.
, ,.... ,; rrr C:,r, (
fttec. 1'['xrrr' `.:rck
rkleit! P"rwii F('e.
P/!!.'.. '. P(v mil 1,
tl.. Permst rc'C
Orlier .lterir. rasp 1
01.. r ��/rI nh f 5r)Li
(ilhvi` Elv( tiiSf�.ET
14'-e Fr. N„p. ["ce.
r>rroub. lely. Fcc'.
171e� . I,;sp' r� �,
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eft' 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
F__17 hours Plan Check, Hourly
$130.00 ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes 0 No
$0.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ConsIrm-tion Tax.
Ad,rtirri.�trirrii<< F�Eo:
Select a Non -Residential
Building or Structure
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
0 hours Inspections
$260.00 ISTINSP Inspection, Hourly
0
0�
I!"c!1'E�l %..�0{:1(N7r'litGtji)PI l•cres:
Strong; Motion Fee: IBSEISMICO
$1.09
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.09
$390.00
TOTAL FEE:
1 $392.09
Revised: 04/01 /2012